Trauma Care Reimbursement

GAO looked at the compensation received by four trauma centers in California, New Mexico, and Texas for treatment they provided to undocumented aliens. Three of the centers did not have any major problems obtaining Medicaid reimbursement. Representatives of the fourth facility said that they had not received such payments and had no indication from the state that emergency treatment for undocumented aliens would be covered by Medicaid. GAO confirmed that the state has never published this information. In an effort to support requests for financial aid or to track the sources of uncompensated care, the three facilities receiving Medicaid reimbursement had also tried to estimate the cost of providing services to undocumented aliens. GAO, however, found important methodological weaknesses in each facility's analysis. Nonetheless, an objective procedure for using routinely collected information to assess immigration status accurately is a potentially fruitful strategy that might be implemented at modest cost in a variety of settings.

GAO found that: (1) direct approaches to identifying undocumented aliens are expensive and inaccurate, because of the need to collect data apart from normal hospital procedures and undocumented aliens' presumed preference for concealing their status; (2) indirect approaches to identifying undocumented aliens currently employ unvalidated methods for inferring patients' immigration status; (3) the direct approach to linking undocumented patients to uncompensated costs first identifies the costs attributed to patients classified as undocumented, then credits payments received for these accounts and an appropriate portion of general operating support, which may not be linked to patient accounts; (4) the direct approach can lead to overstated uncompensated costs by failing to credit a portion of operating assistance not directly linked to patient accounts and failing to discount hospital charges to actual costs; (5) another approach uses the proportion of patients determined to be undocumented, multiplied by the net cost of the hospital service in question; and (6) the other approach assumes that undocumented aliens have service utilization and payment patterns similar to other patients.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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